The SEER/Medicare Linkage Project is a collaborative effort by the National Cancer Institute (NCI) and the Health Care Financing Administration (HCFA). The study will link two complex databases: the NCI's Surveillance, Epidemiology, and End Results Program database containing information on cancer cases diagnosed and reported in nine geographically distinct population-based tumor registries; and HCFA's Medicare statistical system that contains extensive billing information for the health care of the disabled and more than 95 percent of the elderly. The Analytical Epidemiology Section (AES) is working in collaboration with the NCI to analyze the data on oral and pharyngeal cancer patients. This extremely large and complex data base will allow for extensive analysis of patterns of health care among persons 65 years of age and older subsequent to a diagnosis of oral or pharyngeal cancer. Specific objectives of this study are to: (1) identify determinants of choice of first-course of cancer-directed therapy among individuals 65 years of age and over with oral cavity and pharyngeal cancer, by site of cancer; (2) identify medical and sociodemographic determinants of morbidity, health care utilization, and mortality among oral and pharyngeal cancer patients, and (3) estimate the lifetime costs associated with oral cavity and pharyngeal cancer. For the years 1984 to 1993, more than 30,000 incident cases of oral cavity, pharyngeal and laryngeal cancer are contained in the data base. This year the database was updated to include laryngeal cancer and to include cases through 1993 and to increase the follow-up period accordingly. An analysis was undertaken to determine the extent to which esophagoscopy and bronchoscopy are being used to screen for multiple oral and pharyngeal cancer in patients who have a cancer diagnosis in those anatomic sites. Marked geographical differences in the proportion undergoing bronchoscopy or esophagoscopy were observed even when other characteristics such as age, gender, tumor site, co-morbidity, and socioeconomic status were taken into account. This variation underscores the uncertainty in the medical community about the advisability of these screening tests as part of the diagnostic work-up of patients with upper aerodigestive cancers, who frequently have synchronous cancers in other aerodigestive or respiratory anatomic sites.